Locked In
This article is scheduled to be the featured article for April, 2012. Please help us improve it in the meantime. '' '''Locked In' is a fifth season episode of House which first aired on March 30, 2009. In a special episode of House, shot and told predominantly from the perspective of a patient, Mos Def guest-stars as Lee, a man who awakens in a small town in New York state after a bicycle accident unable to move or communicate in any way apart from blinking his eyes. House, himself injured in a motorcycle mishap, occupies the hospital bed next to Lee and quickly annoys the doctors treating them both by insisting that Lee has "locked-in" syndrome. After House gets Lee transferred to Princeton Plainsboro, the team is on the case to try to "unlock" him. Meanwhile, Wilson suspects House is hiding something when he refuses to divulge why he was in New York. Recap A patient in a hospital in Middletown, New York is regaining consciousness, but cannot move his legs. The doctors are talking about transplanting his organs when he hears House (who is in the hospital because of a motorcycle accident and is a patient in the emergency room himself), who thinks he is still alive despite the lack of response on the EEG. He has noted that the patient's eyes are following him. House thinks he has locked-in syndrome and asks the patient to blink, which he can. The patient’s attending physician realizes House is right when the patient shows obvious signs of voluntary movement of his eyes and can respond to questions. The patient remembers he was in a bicycle accident. He is told that his brain has separated from the rest of his nervous system, which has caused his paralysis . House thinks that the patient may have had brain damage before the crash which caused the crash, rather than being the result of brain trauma. The patient remembers he could not apply the brakes on his bicycle. House looks at the patient’s hands, which show no sign of him using them to protect himself as he fell. The attending thinks the patient's condition is permanent, but House tells the patient that he could have a treatable condition. The patient sees his wife. House is looking at the patient’s X-rays. The patient communicates that he does not want his kids to see him in his condition. His wife kisses him and leaves. Suddenly, House's team (minus Taub) arrives. They start doing a differential. Thirteen thinks he might have a brain tumor, and House is hopeful that Thirteen's diagnosis is correct because they could treat it. House has stolen some forms so he can get the patient into the MRI. The team does an MRI of the patient. They put goggles on him, and he starts having a vision of talking to House on the beach. They talk about the patient's belief in God and how he goes to church to please his wife. The patient thinks God sent House to help him. The patient sees his kids playing on the beach. House goes to see the patient. The MRI found a lesion which House thinks is a tumor most likely causing paraneoplastic syndrome. House discontinues the anti-viral medication prescribed by the attending, who thinks the patient just has an infection. The patient realizes House is a little nuts for being obsessed about his inability to communicate. Suddenly the patient has a seizure. House is arguing with the attending about the cancer, and the wife realizes the patient wants to go with House. House manages to get the patient transferred to Princeton-Plainsboro so he can do plasmapheresis. Cuddy meets House and asks if he has recovered from his motorcycle accident. The patient realizes that House and Cuddy like each other. Taub shows up and House tells him that he has accepted his resignation. Taub says he did not resign. Wilson meets House and asks why he was in Middleton - he thinks House was there to get prescription painkillers. House tells Wilson he was there to see Wilson’s first wife to tell him how much money he is making for lectures. The patient is shocked by House's drug use. Kutner and Taub are discussing what House is up to with Taub's employment. Suddenly, they see something and go to get House. When House returns, Taub ask the patient if he drinks and Kutner starts talking about opiates. House wants to biopsy the lesion in his brain. Thirteen tells the patient he has blood in his urine and catheterizes him. The patient's kids arrive, but the patient does not want them there. The patient thinks he might be dying and his kids are there to see him before he does. Thirteen asks the wife and kids to leave and tells the patient he has been crying. Chase talks to the patient before doing the biopsy. He is put under anesthetic. He starts thinking about being on the beach with House and his kids. They start talking about God again. House says he does not know if he is going to be all right. The patient regains consciousness and starts answering questions on cards. However, he soon loses the ability to blink. House tells the wife that the biopsy may have taken away his ability to blink as that part of the brain was near the biopsy site. They start talking about the result of the biopsy. House thinks the patient may be brain dead. The biopsy was useful - it revealed damage to the myelin sheath, but they still do not know why. They do a differential, but they need a better medical history, which means they need to ask him questions. Taub suggests a brain/computer interface. They hook up the patient to the machine and tell him to think "up". Wilson has called his first ex-wife, who has been in Mexico. He asks why House is evading questions about being in New York. House says he was visiting Foreman's brother in prison. Taub is telling the patient about his work problems. Suddenly, the computer interface seems to be responding. Taub realizes the patient is still alive. His wife comes in and sees the monitor respond. We hear the patient thinking again. House starts taking a medical history. The wife says the patient was in St. Louis, but the patient denies it. House realizes he lied to her about being in St. Louis. House tries to find out where the patient was, but thinks he is lying about not being with a woman. Neurosyphillis would explain the symptoms. Taub thinks the patient is telling the truth. House starts questioning him and realizes he was at a friend's house. Taub and Kutner go to do an environmental scan of the friend's house. The patient was apparently working as a janitor at a factory because his roofing business was suffering. They go to do an environmental scan of the factory and find cadmium dust - it might be heavy metal poisoning. They start chelation therapy. Taub thanks the patient for responding. Foreman talks to the patient about buying a necklace for his first girlfriend, who did not like it. The patient thinks Foreman is boring. Foreman thinks Thirteen did not like the bracelet he bought and wishes she could just have the guts to tell him so. The patient is more impressed that he is dating Thirteen. The wife asks him why he lied to her. His thoughts indicate that the last time he told her business was slow, she had migraines every day. Taub goes to see House to tell him he still wants his job. House tells him to come up with a good idea - the computer was somebody else's idea (the guy who invented it). Taub tells House that the job terrifies him and that overcoming his fear is the only way for him to matter. However, House points out that finding out about the factory and cadmium was still Kutner's idea. Thirteen is about to close the patient’s eyes, but notices something and gives the patient eye drops with dye in them to get a good look at his cornea. She sees ulcerative keratitis and she and Foreman realize it is not cadmium poisoning. House is studying the whiteboard when Cameron comes in to treat his injuries from his accident. The patient's kidneys are failing and he is losing the myelin sheath from his nerves. House deliberately swallows all the narcotics Cameron gives him. Cameron suggests giving the patient a lumbar puncture and explains why it is a good idea. House asks why he fired her, but Cameron reminds House he did not fire her, she quit. Wilson knows House wasn't visiting Foreman's brother and asks him why he was there again. House wonders why Wilson is so obsessed. House says he was up there checking out Wilson's new girlfriend. House suspects Wilson feared that all along. Wilson is astounded, but admits he is seeing one of the nurses who is treating his brother Danny. Foreman prepares for the lumbar puncture. Suddenly, the patient has a heart attack. He is back on the beach again, but denying the existence of God. The House in the vision admits that he does not know what is wrong. Kutner manages to revive the patient. They are arguing when House tells them to shut up because the patient appears to be trying to communicate. The patient finally communicates he has an itch in his right foot. House realizes his liver has failed completely. Foreman comes up with sclerosing colangitis and House orders a biopsy. They prepare for the biopsy and Thirteen says she likes the bracelet Foreman got her, she just doesn't want to wear it at work where it can get patient fluids on it. Suddenly, Kutner notices a rash on her wrist. Thirteen admits that she got some of the patient's urine on her wrist. Kutner thinks the patient may have an infection that he passed on to Thirteen, leptospirosis, that is found in rats like the ones in the friend's house. That would cause the liver failure and result in the release of toxins that would cause the locked-in syndrome. They find a paper cut on his hand where the infection could have entered. They find rats at the friend‘s home that test positive for leptospirosis. They start treatment and ask the patient to try to move. Kutner tells him to try harder. The patient finally moves his right index finger. House comes to the team to congratulate them. Taub claims credit for coming up with the diagnosis, but House realizes that it was really Kutner's idea. However, House does not mind because it shows Taub cares about the job. Wilson realizes that House wasn't up in Middletown scoping out his girlfriend, and has stolen House's pager, which he hasn't been answering while Wilson has been with him. Wilson called the pager number and got in touch with House's psychiatrist. House silently walks away. When they reach the patient's room, House angrily tells Wilson he had no right to invade his privacy. Lee tells House God sent him, and House tells the patient he’s no longer interesting. House says he's not going back because the psychiatry isn't working. Wilson tells him he will wind up alone. Characters Cast *Hugh Laurie as Gregory House *Lisa Edelstein as Lisa Cuddy *Omar Epps as Eric Foreman *Robert Sean Leonard as James Wilson *Jennifer Morrison as Allison Cameron *Jesse Spencer as Robert Chase *Peter Jacobson as Chris Taub *Kal Penn as Lawrence Kutner *Olivia Wilde as Remy Hadley Guest Stars *Mos Def as Lee *Faune A. Chambers as Molly *John Kapelos as Dr. Kurtz *Skye Barrett as Jolie *Scotty Noyd Jr. as Drake *Bobbin Bergstrom as Nurse Major Events * House reveals that he was in New York to go see Foreman's brother but Wilson soon discovers that he has in fact been seeing a psychiatrist . Zebra Factor 8/10 Leptospirosis is very rare in temperate climates like New Jersey, with only about one in 5 million people getting infected in a given year (about 60 cases a year in the United States). Locked-in syndrome is even rarer, with only a few dozen recorded cases. Trivia & Cultural References *House talks about the patient's doctor teaching him to blink out "kill me" in Morse Code - this is an allusion to the 1971 film Johnny Got His Gun (the film whose footage appeared in Metallica's music video "One") where a patient in a similar situation communicates through Morse Code by squeezing hands, and asks the Nurse to kill him. *Middletown, New York is a town of about 25,000 that is just north of the New Jersey/New York border. *The Gibson Goldtop is a variety of the Gibson Les Paul, named after one of the primary developers of the electric guitar. *Duane Allman was a guitarist and co-founder of the Allman Brothers Band who died in a motorcycle accident in 1971. *Fishkill is a medium security prison in Fishkill, New York, on the Hudson River north of New York City. *More about Computers that can read your mind! *Oedipal refers to a theory in psychology that men are driven by a subconscious desire to possess their mother and kill their father. It is named after the story of Oedipus Rex, whose parents abandoned him when it was predicted he would marry his mother and kill his father. Oedipus was adopted and when he heard the same prediction, he abandoned the people he thought were his parents to avoid the prophecy, and instead encountered his biological father, who he killed in a dispute, and went to marry the man’s widow. When he found out the truth, he removed both of his eyes to punish himself. *"Save the cheerleader, save YOUR world." After returning to PPTH, House tells Taub he may or may not have accepted his resignation. He says this quote to Taub as advice on how to keep his job. This quote is a reference to the theme of the first season of NBC TV show, Heroes Reviews The episode received generally positive reviews *TV.com users rated the episode an 8.7 *IMDB users rated the episode a 9.1, with over 63% of users giving it a 10. . International Air Dates *Canada: March 30, 2009 (Global) *Australia: April 8, 2009 (Channel 10) *Latin America: May 7, 2009 (International Channel) *Denmark: August 8, 2009 (Kanal 4) *Netherlands: October 29, 2009 (SBS6) *Poland: November 4, 2009 (TVP2) *Germany: November 10, 2009 (RTL) *Slovakia: December 1, 2009 (STV1) *Czech Republic: March 24, 2010 (TV Nova) *Sweden: April 6, 2010 (TV4) Links *Episode article at Wikipedia *Episode page at TV.com *Episode page at IMDB *Episode recap at Cinema Blend *Episode page at House MD Guide *Episode review at Blogcritics *Review of the medicine at Polite Dissent *Episode guide at TV Fanatic *Episode guide at MSN *Episode recap at Buzzsugar *Episode transcript at Clinic Duty *Episode article at TVIV *Episode review at AOL TV Category:Episodes Category:Season 5 Category:Huddy